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Socioeconomic Status, Smoking, and Lung Cancer: Mediation and Bias Analysis in the SYNERGY Study
J. Hovanec, B. Kendzia, A. Olsson, J. Schüz, H. Kromhout, R. Vermeulen, S. Peters, P. Gustavsson, E. Migliore, L. Radoi, C. Barul, D. Consonni, NE. Caporaso, MT. Landi, JK. Field, S. Karrasch, HE. Wichmann, J. Siemiatycki, ME. Parent, L....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
Grantová podpora
001
World Health Organization - International
- MeSH
- analýza mediace * MeSH
- dospělí MeSH
- kouření * epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- nádory plic * epidemiologie MeSH
- odds ratio MeSH
- rizikové faktory MeSH
- senioři MeSH
- společenská třída * MeSH
- studie případů a kontrol MeSH
- zkreslení výsledků (epidemiologie) * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Increased lung cancer risks for low socioeconomic status (SES) groups are only partially attributable to smoking habits. Little effort has been made to investigate the persistent risks related to low SES by quantification of potential biases. METHODS: Based on 12 case-control studies, including 18 centers of the international SYNERGY project (16,550 cases, 20,147 controls), we estimated controlled direct effects (CDE) of SES on lung cancer via multiple logistic regression, adjusted for age, study center, and smoking habits and stratified by sex. We conducted mediation analysis by inverse odds ratio weighting to estimate natural direct effects and natural indirect effects via smoking habits. We considered misclassification of smoking status, selection bias, and unmeasured mediator-outcome confounding by genetic risk, both separately and by multiple quantitative bias analyses, using bootstrap to create 95% simulation intervals (SI). RESULTS: Mediation analysis of lung cancer risks for SES estimated mean proportions of 43% in men and 33% in women attributable to smoking. Bias analyses decreased the direct effects of SES on lung cancer, with selection bias showing the strongest reduction in lung cancer risk in the multiple bias analysis. Lung cancer risks remained increased for lower SES groups, with higher risks in men (fourth vs. first [highest] SES quartile: CDE, 1.50 [SI, 1.32, 1.69]) than women (CDE: 1.20 [SI: 1.01, 1.45]). Natural direct effects were similar to CDE, particularly in men. CONCLUSIONS: Bias adjustment lowered direct lung cancer risk estimates of lower SES groups. However, risks for low SES remained elevated, likely attributable to occupational hazards or other environmental exposures.
Boston College Chestnut Hill MA
Cancer Epidemiology Unit Department of Medical Sciences University of Turin Turin Italy
Comprehensive Pneumology Center Munich Munich Germany
Dalla Lana School of Public Health University of Toronto Toronto Canada
Department of Cardiovascular Sciences and Public Health University of Padova Padova Italy
Department of Medical and Surgical Sciences University of Bologna Bologna Italy
Environmental Research Group School of Public Health Imperial College London United Kingdom
Epidemiology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
Faculty of Medicine Palacky University Olomouc Czech Republic
Health Research Institute of Asturias University of Oviedo ISPA and CIBERESP Spain
Institute for Risk Assessment Sciences Utrecht University Utrecht The Netherlands
Institute of Hygiene and Epidemiology 1 Faculty of Medicine Charles University Prague Czech Republic
International Agency for Research on Cancer Lyon France
Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany
Masaryk Memorial Cancer Institute Brno Czech Republic
National Cancer Institute Bethesda MD
National Institute of Public Health Bucharest Romania
National Public Health Center Budapest Hungary
National Research Council Palermo Italy
Occupational Cancer Research Centre Ontario Health Toronto Canada
Regional Authority of Public Health Banska Bystrica Slovakia
Stony Brook Cancer Center Stony Brook University Stony Brook NY
The Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
The Nofer Institute of Occupational Medicine Lodz Poland
Université Rennes Inserm EHESP Irset UMR_S 1085 Pointe à Pitre France
University of Montreal Hospital Research Center Montreal Canada
Citace poskytuje Crossref.org
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